Please complete this form if your state of health means that you are unable to work when a recent sick / fit note (‘Fitness to Work Certificate’) ends.

The doctor may call you or arrange for an appointment.

If the doctor has enough information to issue a new sick / fit note, we will try to have this ready for collection within 2 working days. Please note that sick / fit notes can be backdated so any time off will be accounted for.

It is not normally necessary to see a doctor before your return to work at the end of the sickness period and you can go back to work sooner if you feel well enough and have informed your employer.